Measurement of DNA in intervertebral disc and other autofluorescent cartilages using the dye hoechst 33258.
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Animals↗
Biomedical subjects
R B Lee
Publications and source records attributed to R B Lee.
Evaluation of treatment modalities for thoracic empyema: a cost-effectiveness analysis.
BACKGROUND: Empyema thoracis is treated with a multitude of therapeutic options. Optimal therapy and cost-containment requires selection of the most appropriate initial intervention. METHODS: A retrospective review of treatment modalities was performed on 77 patients diagnosed with empyema thoracis from 1990 to 1997 at one institution. Mean age was 59 years (range, 21 to 90 years); 52 were men and 25 were women. RESULTS: Sixty-five percent (50/77) were parapneumonic and 68% (52/77) were multiloculated. Treatment modalities were as follows: group 1, antibiotics only (n = 4); group 2, primary intervention: image-directed catheter (n = 20) or tube thoracostomy (n = 24); and group 3, secondary intervention: decortication (n = 17), rib resection or muscle interposition (n = 12). Thirty-four percent (9/20 image-directed catheter and 8/24 tube thoracostomy) had failure of initial intervention. Patients undergoing decortication more often had multiloculated empyema thoracis (16 of 17) compared with those undergoing image-directed catheters (8 of 20) or tube thoracotomy (16 of 24). Length of stay was reduced for decortication patients (17 days) compared with those having image-directed catheters (21.8 days), failed image-directed catheters (29.7 days), or tube thoracostomies (19.6 days). Hospital charges per patient between decortication and image-directed catheter ($34,770.79 versus $37,869.41) were comparable, but charges were significantly decreased in decortication patients as compared with failed image-directed catheters ($55,609.32; p < 0.05). CONCLUSIONS: Our series revealed that early decortication has charges similar to those of primary intervention (image-directed catheter or tube thoracostomy) but is more cost-effective than failed image-directed catheter. We advocate the use of early surgical intervention as the most optimal and cost-effective initial modality for the treatment of empyema thoracis.
Anti-Bacterial Agents↗
Cognitive screening examinations for silent cerebral infarcts in sickle cell disease.
OBJECTIVE: In children with sickle cell disease (SCD), silent cerebral infarcts are the most frequent cause of neurologic injury. We determined the sensitivity and specificity of selective neurocognitive measures when separating children with silent cerebral infarcts and SCD from sibling controls. Additionally, we tested the validity of the same cognitive measures to identify patients with overt strokes. METHODS: We examined performance on a neuropsychologic battery containing measures of attention/executive, spatial, language, memory, and motor functioning for seven children with SCD and silent cerebral infarct, 21 children with SCD and overt stroke, and 17 normal siblings. Diagnosis of cerebral infarct was based on results of MRI. RESULTS: Measures from the attention and executive domains were the most useful for identifying children with silent cerebral infarct. The Test of Variables of Attention was the most robust measure and yielded a sensitivity rate of 86% and a specificity rate of 81%. This measure also showed a sensitivity rate of 95% in identifying overt stroke. CONCLUSIONS: Brief cognitive screening measures, if properly constructed, may be an effective means of identifying children with silent cerebral infarct. Future prospective studies should be pursued to assess the utility of cognitive screening for silent cerebral infarcts in SCD.
Adolescent↗
Pathologic findings in lung volume reduction surgery.
PURPOSE: Lung volume reduction surgery (LVRS) has re-emerged as an alternative in the management of patients with chronic, debilitating, emphysematous lung disease. This has permitted the formal evaluation of pathologic pulmonary changes present in these patients. This study seeks to describe systematically the pathologic findings present in patients undergoing LVRS. METHODS: Tissue sections stained with hematoxylin-eosin, as well as special stains, were retrospectively reviewed from the specimens of 65 nonconsecutive LVRS patients (male patients, 66%; female patients, 31%; mean age, 63.2+/-6.76 yr). All operations were conducted via an open technique (bilateral, 83%; unilateral, 17%). RESULTS: Histologic emphysema grade was mild in 9%, moderate in 72%, and severe in 19% of patients. Microscopic bullae were noted in 75% of specimens. Three patients, each with radiographic evidence of a lesion preoperatively, had small (1.1 to 2.8 cm) adenocarcinomas. Granulomatous bronchiolitis and pneumonitis were noted in one patient who postoperatively developed progressive respiratory compromise. An old, inactive aspergilloma was found in the specimen of another patient. Additional findings of potential clinical significance included bronchiolitis (54), bronchiolectasis (6), and bronchoalveolar metaplasia (1). Incidental findings included interstitial fibrosis and scar (55), interstitial inflammation (20), calcification (20), and ossification (11), bone marrow emboli (4), chemodectoma (2), and carcinoid tumorlets (1). CONCLUSION: This systematic analysis of the resected specimens from patients undergoing LVRS describes a wide range of pathologic findings, including those clinically relevant, as well as incidental. As the application of LVRS continues to expand, the likelihood of discovering clinically significant pathologic lesions (eg, carcinoma) will undoubtedly increase.
Aged↗
Evidence for a negative Pasteur effect in articular cartilage.
Uptake of external glucose and production of lactate were measured in freshly-excised bovine articular cartilage under O2 concentrations ranging from 21% (air) to zero (N2-bubbled). Anoxia (O2 concentration < 1% in the gas phase) severely inhibited both glucose uptake and lactate production. The decrease in lactate formation correlated closely with the decrease in glucose uptake, in a mole ratio of 2:1. This reduction in the rate of glycolysis in anoxic conditions is seen as evidence of a negative Pasteur effect in bovine articular cartilage. Anoxia also suppressed glycolysis in articular cartilage from horse, pig and sheep. Inhibitors acting on the glycolytic pathway (2-deoxy-D-glucose, iodoacetamide or fluoride) strongly decreased aerobic lactate production and ATP concentration, consistent with the belief that articular cartilage obtains its principal supply of ATP from substrate-level phosphorylation in glycolysis. Azide or cyanide lowered the ATP concentration in aerobic cartilage to approximately the same extent as did anoxia but, because glycolysis (lactate production) was also inhibited by these treatments, the importance of any mitochondrial ATP production could not be assessed. A negative Pasteur effect would make chondrocytes particularly liable to suffer a shortage of energy under anoxic conditions. Incorporation of [35S]sulphate into proteoglycan was severely curtailed by treatments, such as anoxia, which decreased the intracellular concentration of ATP.
Adenosine Triphosphate↗
Belsey Mark IV antireflux procedure for complicated gastroesophageal reflux disease.
BACKGROUND: Over the past 20 years, medical management of gastroesophageal reflux disease has met with increasing success, but a proportion of patients continue to have symptoms or complications requiring surgical treatment. The variety of operations available attests to the general lack of satisfaction with any single procedure. METHODS: A retrospective study was conducted of 276 patients who underwent the Belsey Mark IV antireflux procedure at our institution between 1979 and 1995. The indication for operation was gastroesophageal reflux disease refractory to medical therapy in 137 patients, gastroesophageal reflux disease with symptomatic stricture or Schatzki's ring in 36, achalasia or epiphrenic diverticulum in 74, paraesophageal hernia in 27, and esophageal mass in 2. Fifteen patients (5.4%) had undergone prior antireflux operations. RESULTS: There was one perioperative death (0.4%) resulting from an apparent myocardial infarction in an 87-year-old woman who underwent operation for paraesophageal hernia with volvulus. Two patients had contained leaks diagnosed by routine postoperative contrast studies; both were managed successfully without operation. Two patients required early reoperation for recurrent symptoms: 1 underwent a repeated Belsey Mark IV procedure and the other underwent an esophagogastrectomy. An additional 7 patients experienced late recurrence of symptoms requiring surgical management. The overall complication rate was 10.1%, with minor pulmonary complications (2.1%) and atrial arrhythmias (1.8%) occurring most commonly. CONCLUSIONS: The Belsey Mark IV procedure is a safe and effective operation for the management of gastroesophageal reflux disease with complications, and it compares favorably with other antireflux procedures.
Adolescent↗
Esophagectomy for cancer.
We are faced with the challenge of treating, palliating, or curing esophageal cancer, considered by some to be the most insidious of cancers. This article acquaints the reader with historic milestones regarding resection of esophageal cancer, preoperative evaluation and preparation, and the various techniques currently being used to perform esophagectomy for cancer.
Cardia↗
Pruritus in HIV-1 disease: therapy with drugs which may modulate the pattern of immune dysregulation.
BACKGROUND: Pruritus in HIV-1+ patients is common and increases with disease progression. The causes of pruritus are numerous including xerosis, drug and photoeruptions, follicular and papular eruptions as well as infestations and infections by a wide range of organisms. One other possible factor contributing to pruritus is the pattern of immune dysregulation. With advancing HIV-1 disease there is Th1 to Th2 cytokine switching. METHODS: After some positive results with prostaglandin inhibitors, we undertook a study in which we randomly placed patients on four different forms of therapy for their pruritus. The therapies included hydroxyzine with or without doxepin at night, pentoxifylline, indomethacin and topical moisturization with medium-strength topical steroids. All patients were evaluated for both subjective relief as well as side effects. RESULTS: Patients placed on indomethacin obtained relief more consistently and more completely. Patients on pentoxifylline had the fewest side effects of all oral therapies. Patients on antihistamines with or without doxepin had the highest incidence of side effects, although more of these patients reported a greater degree of relief than patients on pentoxifylline. All patients on oral therapy overall had greater relief than patients using topical steroids. CONCLUSION: The systemic therapies which may modulate the pattern of immune dysregulation seen in HIV-1 disease may be beneficial in the pruritus seen in late-stage patients.
Administration, Cutaneous↗
Traumatic injury of the cervicothoracic trachea and major bronchi.
Interstate highways and crowded urban areas have become the "battlefields" of the 1990s. The weapons are motor vehicles, handguns, and knives. This article relates the historical perspective, diagnosis, and management of traumatic injury to the cervicothoracic trachea and major bronchi. The etiologic factors are explained in depth. Examples of the current management of cervicothoracic tracheal injuries, including resection, primary repair, and the use of autogenous tissue to buttress or wrap the repair, are explained and illustrated.
Adult↗
Lung volume reduction surgery: lessons learned.
BACKGROUND: The concept of lung volume reduction for generalized emphysema was proposed by Brantigan and associates in 1958 and reintroduced by Cooper and colleagues in 1994. The present study presents lessons learned from an 18-month experience. METHODS: From August 1, 1994, to August 1, 1995, 53 patients underwent lung volume reduction at Emory University for generalized emphysema. There were 17 women and 36 men ranging in age from 55 to 75 years. The length of stay ranged from 10 to 59 days. At the time of presentation, 47 patients were receiving oxygen and 35 were receiving steroids. Forty-six patients were operated on using a median sternotomy and 7 through a unilateral thoracotomy. All patients underwent preoperative and postoperative pulmonary rehabilitation. RESULTS: There was one early death and four late deaths. Lessons learned from this group of patients are presented. CONCLUSIONS: Lung volume reduction surgery remains a sea of relatively uncharted waters, with the future direction yet to be determined.
Aged↗
Radiologic evaluation and intervention for empyema thoracis.
Empyema thoracis has changed little in its presentation and etiology since first described. Surgical intervention, simply put, is "drainage of pus." The introduction of computed tomography and catheter drainage of empyema is the first technologically driven advancement for the management of empyema. The use of various radiologic procedures for characterization and treatment of empyema is described.
Diagnosis, Differential↗
Role of transesophageal echocardiography in the management of patients with bronchogenic carcinoma invading the left atrium.
TEE played a significant role in the management of 2 patients by defining the extent of cardiac invasion. We believe TEE would be helpful in patients presenting with thoracic tumors believed to be encroaching on cardiac structures, where consideration is being given to surgical resection of the tumor.
Aged↗
Tracheal resections: lessons learned.
Tracheal resection and primary anastomosis can be performed for the management of congenital, traumatic, iatrogenic, and neoplastic etiologies of tracheal stenosis. During a 19-year period, we performed 45 tracheal resections on 38 patients with low operative mortality (7.9%) and morbidity. One patients had congenital tracheal stenosis (group 1); 4 patients had stenosis resulting from traumatic lesions (group 2); 18 patients had stenosis caused by tracheostomy or endotracheal tubes (group 3); and 15 patients had stenosis caused by a variety of neoplastic lesions (nine primary and six secondary) (group 4). Preoperative evaluation and surgical and anesthesia management are described. Eight tracheal stents were used (three Neville prostheses and five Montgomery T tubes). Disastrous results occurred with the Neville prosthesis, but acceptable results were obtained when the Montgomery T tube was used. There were several "lessons learned" during the evolution of this series. Chest roentgenograms are not useful. Tracheal tomography and computed tomography are extremely informative in evaluation of iatrogenic and neoplastic lesions. Proper mobilization allows primary anastomosis after almost all resections. Excellent results were obtained with iatrogenic lesions. Increased mortality and morbidity occur in patients undergoing resection for neoplastic lesions; however, 5-year survival is good, and results are gratifying.
Adolescent↗
Hemorrhagic shock in endotoxin-resistant mice: improved survival unrelated to deficient production of tumor necrosis factor.
Although tumor necrosis factor (TNF) has been implicated in sepsis-induced mortality, its role in the pathophysiology of hemorrhagic shock (HS) remains ill defined. We studied three groups of acutely anesthetized mice undergoing HS to determine the role of TNF in HS mortality. Shock was initiated in each group after heparinization by arterial bleeding of 4 mL/100 g body weight followed by 12 mL/100 g body weight resuscitation with normal saline at 1 hour. The C3H/HeJ mice (n = 14), characterized by a genetic defect in macrophage production of TNF and other cytokines in response to endotoxin, were compared with the closely related C3H/HeN strain (n = 18), which do produce TNF. A second group of C3H/HeN mice were passively immunized to TNF by pretreatment with 2.5 mg/kg anti-murine TNF antibody (Ab) before HS. In contrast to the high TNF levels measured following HS in C3H/HeN controls, post-HS TNF was undetectable in C3H/HeJ mice. Five-day survival rate and survival time were significantly greater in C3H/HeJ mice when compared with C3H/HeN controls. Anti-TNF Ab pretreatment of C3H/HeN mice abolished the increase in TNF but did not improve survival. The data demonstrate a striking improvement in survival of TNF-deficient C3H/HeJ mice following severe HS. However, the improved survival does not appear to result from deficient TNF production, since Ab pretreatment did not decrease HS mortality. The improved survival in C3H/HeJ mice suggests that cytokines other than TNF may play a role in the pathophysiology of HS.
Animals↗
Intraperitoneal P-32 is not an effective consolidation therapy after a negative second-look laparotomy for epithelial carcinoma of the ovary.
Thirty-four patients with epithelial carcinoma of the ovary were entered into a trial of adjuvant intraperitoneal P-32 following induction chemotherapy and a negative second-look laparotomy. The breakdown by initial Stage was Stage IC, 5; Stage II, 3; Stage III optimal, 22; and Stage III suboptimal, 4. Previous treatment consisted of 4-12 cycles (median 6) of cisplatin or carboplatin-based combination chemotherapy. Fifteen millicuries of P-32 were instilled via a Tenckhoff catheter placed at the time of second-look laparotomy. Because of a 22% incidence of bowel injury in the first 23 patients, the P-32 dose was reduced to 12 mCi in the last 11 patients. To date, there have been no bowel injuries at the lower dose. Eighteen of the 34 (53%) patients have relapsed with a median time to relapse of 20 months and a median follow-up for all patients of 31 months. There has been no difference in the relapse rate between a dose of 12 and 15 mCi. Intraperitoneal P-32 does not appear to reduce the relapse rate following a negative second-look laparotomy. The incidence of bowel injury is dose dependent and is higher than that seen in patients treated as an adjuvant following initial surgery without subsequent chemotherapy or second-look laparotomy.
Adult↗
Amphicrine carcinoma of the uterine cervix.
A case of amphicrine carcinoma of the uterine cervix is described in a 27-year-old woman whose initial cervical biopsy specimen showed small cell undifferentiated neuroendocrine carcinoma. Despite an initial complete clinical response to VP-16 and carboplatin, residual tumor was noted in the cervical cone biopsy specimen and she was treated with external-beam irradiation and cesium implants. The neoplasm subsequently metastasized and required additional VP-16 and carboplatin for control. The pathologic features and biologic behavior of this unusual type of neuroendocrine neoplasm are described in this case report.
Adult↗
Strengthening of feldspathic porcelain by ion exchange and tempering.
This study investigated the effectiveness of tempering and ion-exchange treatments on crack growth and bi-axial flexural strength of seven feldspathic porcelains. The results showed that tempering treatment was more effective in strengthening porcelain than was the ion-exchange process as measured by the bi-axial flexural strength. However, the results of initial crack size induced by a microhardness tester showed that ion-exchange yielded a surface that was more resistant to crack initiation than was that yielded by the tempering treatment. EDX and microprobe analyses showed that there was evidence of exchange between Na+ within the porcelain surface and K+ from the ion-exchange agent applied on the surface.
Aluminum Silicates↗
Free jejunal interposition of the esophagus.
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Contraindications↗